脑小血管病认知障碍特点及与影像学总负荷评分的关系

Characteristics of cognitive impairment in cerebral small vascular disease and its relationship with total imaging load score

目的探讨脑小血管病(cerebral small vessel disease,CSVD)认知障碍特点及与影像学总负荷评分的关系。方法采用横断面调查,纳入2016-10—2019-12中山市中医院就诊的脑小血管病患者272例,以MMSE评分进行分组,同时纳入年龄、性别、受教育程度匹配的健康志愿者30例,采集各组人口学信息及血管病危险因素,磁共振检查评价脑小血管病总体负荷评分,利用MoCA量表评估认知水平。结果 CSVD无认知障碍组118例,认知障碍组154例,2组受教育年限、既往卒中病史方面差异有统计学意义(P<0.05)。各组MoCA总分存在显著差异,认知障碍组视空间及执行功能、记忆、语言、注意、计算方面,评分明显下降(P<0.05)。以总负荷评分对CSVD患者进行分类,总负荷评分1~2分主要分布于无认知障碍(97.46%)和轻中度认知障碍(76.11%)患者,3~4分则主要分布于重度认知障碍(87.80%)患者,差异有统计学意义(P<0.01)。进一步MoCA认知域评价,在总负荷评分≥1分出现视空间及执行、注意下降,当评分≥3分时认知域受累增多,评分明显降低,出现视空间与执行、记忆、语言、注意力、抽象、计算等多个认知域损害(P<0.05)。结论 CSVD相关认知功能障碍以视空间及执行功能受累为特点,随影像学负荷评分增加,认知功能障碍受损加重。

Objective To investigate the characteristics of cognitive impairment in cerebral small vascular disease(CSVD)and its relationship with total imaging load score. Methods Using a cross-sectional survey,272 CSVD patients were included from october2016 to december 2019,grouped with MMSE scores,and 30 healthy volunteers with matching age,sex and education level were included. Demographic information and vascular disease risk factors were collected in each group. Magnetic resonance examination was used to evaluate the overall load score of cerebral small vessel disease,and MoCA scale was used to assess cognitive level.Results There were 118 cases of CSVD without cognitive impairment and 154 cases of cognitive impairment,and the difference in years of education and the history of previous stroke between the two groups was statistically significant(P<0.05). There were different MoCA total scores in each group,and the scores decreased significantly in visual space and executive function,memory,language,attention,calculation(P<0.05)in cognitive impairment group. The total load score was used to classify CSVD patients.The total load score 1-2 was mainly distributed in patients with no cognitive impairment(97.46%)or mild cognitive impairment(76.11%),and 3-4 points were mainly severe cognitive impairment,reaching 87.80%,the difference was statistically significant(P<0.01). Further evaluation,visual space/execution and attention decreased when the score ≥1 points. When the score ≥3 points,the cognitive domain involvement increased,the score decreased significantly,and multiple cognitive domain lesions such as visual space and execution,memory,language,attention,abstraction,calculation appeared(P<0.05). Conclusion CSVD related cognitive dysfunction is characterized by visual space/executive function involvement,the impairment of cognitive dysfunction is aggravated with the increase of imaging load score.